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胰肾联合移植后内分泌胰腺移植功能延迟。发生率、危险因素及其对长期预后的影响。

Delayed endocrine pancreas graft function after simultaneous pancreas-kidney transplantation. Incidence, risk factors, and impact on long-term outcome.

作者信息

Troppmann C, Gruessner A C, Papalois B E, Sutherland D E, Matas A J, Benedetti E, Gruessner R W

机构信息

Department of Surgery, University of Minnesota, Minneapolis 55455, USA.

出版信息

Transplantation. 1996 May 15;61(9):1323-30. doi: 10.1097/00007890-199605150-00007.

DOI:10.1097/00007890-199605150-00007
PMID:8629291
Abstract

BACKGROUND

The incidence of delayed endocrine pancreas graft function and its impact on long-term outcome after simultaneous pancreas-kidney transplantation are unknown.

METHODS

We studied 54 technically successful adult type I insulin-dependent diabetic recipients of cadaver, whole organ, bladder-drained simultaneous pancreas-kidney transplants (mean age, 37.6 years; 65% male, 35% female; 9% pancreas retransplants; 63% on chronic pretransplant dialysis; mean duration of diabetes, 25.1 years). Insulin was administered during the first 2 weeks after transplantation, as needed, to keep blood glucose < 150 mg/dl. Delayed endocrine pancreas graft function was defined as total, cumulative insulin requirement of > 30 U between day 5 and day 10, and/or > 15 U between day 11 and 15. Quadruple immunosuppression was used for all recipients.

RESULTS

The incidence of delayed endocrine pancreas graft function was 69%. By univariate analysis, delayed endocrine graft function was associated with pretransplant recipient weight > 80 kg (P = 0.04), donor age > 45 years (P = 0.02), and cardiocerebrovascular (P = 0.06) and nontraumatic causes of donor death (P = 0.02). The incidence of acute pancreas rejection episodes was similar for recipients without and with delayed endocrine pancreas graft function. Pancreas graft survival at 1 and 3 years was 94% and 82% without versus 76% and 59% with delayed endocrine graft function (P = 0.03).

CONCLUSIONS

Increased pancreas graft failure after delayed endocrine function was a consequence of insufficient functional reserve (e.g., older donors) rather than increased immunogenicity. Pretransplant reduction of recipient weight and careful donor selection are therefore crucial in order to decrease the incidence of delayed endocrine pancreas graft function and its negative impact on long-term outcome.

摘要

背景

在胰肾联合移植后,延迟性内分泌胰腺移植功能的发生率及其对长期预后的影响尚不清楚。

方法

我们研究了54例技术成功的成年I型胰岛素依赖型糖尿病尸体全器官膀胱引流式胰肾联合移植受者(平均年龄37.6岁;男性65%,女性35%;9%为胰腺再次移植;63%在移植前接受慢性透析;糖尿病平均病程25.1年)。移植后的前2周根据需要给予胰岛素,使血糖<150mg/dl。延迟性内分泌胰腺移植功能定义为第5天至第10天累计胰岛素总需求量>30U,和/或第11天至第15天>15U。所有受者均采用四联免疫抑制方案。

结果

延迟性内分泌胰腺移植功能的发生率为69%。单因素分析显示,延迟性内分泌移植功能与移植前受者体重>80kg(P=0.04)、供者年龄>45岁(P=0.02)、供者心脑血管疾病(P=0.06)和非创伤性死因(P=0.02)有关。有无延迟性内分泌胰腺移植功能的受者急性胰腺排斥反应的发生率相似。无延迟性内分泌移植功能者1年和3年胰腺移植存活率分别为94%和82%,有延迟性内分泌移植功能者分别为76%和59%(P=0.03)。

结论

延迟性内分泌功能后胰腺移植失败增加是功能储备不足(如供者年龄较大)的结果,而非免疫原性增加。因此,移植前减轻受者体重并仔细选择供者对于降低延迟性内分泌胰腺移植功能的发生率及其对长期预后的负面影响至关重要。

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